Public Health Forms
Below are links to our online forms. Forms that are PDFs can either be completed on the computer or by hand and should be sent to the Public Health Unit using the delivery instructions provided on the form.
- Request for School Vaccination Record
All records of vaccination provided in the NSW School Vaccination Program are uploaded onto the Australian Immunisation Register (AIR). Please note, there may be some errors in records of vaccinations given before 2014. If you think your AIR record of school vaccinations is incorrect please call the Public Health Unit on 9382 8333 and ask to speak to an immunisation nurse.
To request your AIR Immunisation History Statement:
- Create a myGov account or log in
- Link your Medicare account in the Services menu
- Proceed to your Medicare Online Account
- Click on the Immunisation History banner and complete the declaration
- Download your Immunisation History Statement
If you are a parent/guardian requesting records for your child who is aged 14 years or older follow this link for more information.
If you do not have an Australian Medicare or myGov account, you should contact the AIR on 1800 653 809 or visit your local general practitioner to request an Immunisation History Statement.
Health professionals should use this form to order Hepatitis B vaccine
- Managing cold chain breach guidelines
- Reporting form for a Cold Chain Breach
- Vaccine cooler temperature chart
It is very important to follow the below steps after you have discovered a cold chain breach:
- Follow managing cold chain breach guidelines above
- Please tape the fridge shut and put a sign on the fridge door- “DO NOT USE” and inform all GPs, practice nurses and practice managers that the National Immunisation Program (NIP- i.e. free Government vaccines) cannot be used until further advice from the Public Health Unit. Do not throw out any NIP vaccines yet.
- Download the data logger and thoroughly check the 5 minute data (not just the graph). Work out the highest and lowest temperatures and how long the temperature was above 8 degrees or below 2 degrees. Ensure the data (not just the graph) is saved as a PDF and attach it to an email. Please ensure the data record covers the period before, during and after the cold chain breach so that the PHU can assess how the fridge normally functions. Please also ensure you attach the current and the previous month’s graph of twice daily min/max thermometer readings.
- Concisely fill out the Reporting form for a Cold Chain Breach above – please note that it is much quicker, easier and preferred if the electronic form is filled out online, then emailed back to this email address SESLHD-PublicHealthUnit-IMMTeam@health.nsw.gov.au . If this is not possible, please print out the hard copy and fill it in neatly by hand and email (or fax to 9382 4309 if you can’t email, but please email to notify that a fax has been sent).
- Do not use the NIP vaccines or the vaccine fridge AND do not throw out any NIP vaccines until given further instructions by the PHU.
- The PHU does not have any jurisdiction over privately bought vaccines- please ring the manufacturer re further use of these vaccines after a cold chain breach.
- If anyone is vaccinated with potentially compromised vaccines, please request a Revaccination Advice Spreadsheet from the Public Health Unit.
- If a cooler was used to store vaccines during a cold chain breach, please, use vaccine cooler temperature chart above to monitor the temperatures while vaccines are in the cooler.
Information and advice about vaccine storage management for Australian immunisation service providers can be found in the National Vaccine Storage Guidelines 'Strive for 5'. NSW Health facilities can also find information in the Policy Directive for Vaccine Storage and Cold Chain Management.